Validation and usefullness of Indian version (CRD Pune) health assessment questionnaire: Drug trials, community practice and COPCORD Bhigwan populatio

Introduction

The advent of HAQ1, 2, 3 (Health assessment questionnaire) caused a major shift in the evaluation paradigm of patients suffering from arthritis and rheumatoid arthritis (RA) in particular. Rheumatologists began to see beyond physical examination and investigations and evaluate pain and disability in the language well understood by the patient. Quality of life (QOL) became the core issue and its measurable improvement a therapeutic target. HAQ is a core set efficacy measure4 and has led to better patient care. Though translated and modified for regional use2 in several parts of the World, its application in the Asian communities remains limited and sparse.

QOL issues differ in our community. People squat and/or sit cross-legged on the floor for several activities. Socioeconomic factors dictate modest and strenuous life styles. A large population lives in underdeveloped areas with little or no basic amenities. But the community is often passionate about customs, traditions and religious practices and reluctant to change life style.

In 1994, we adopted the physical function component of the modified Stanford HAQ (S-HAQ) to design a suitable instrument for Indian (Asian) use.5, 6 Subsequently, we have used the Indian version (CRD Pune Indian HAQ) in several drug trials6, 7, 8, 9 and the maiden WHO ILAR COPCORD (community oriented program for control of rheumatic diseases) India (Bhigwan).7, 10, 11

This is the first comprehensive report on the clinimetric properties of the CRD Pune Indian HAQ, henceforth called Indian HAQ, based on unpublished data from several studies carried out in Center for Rheumatic Diseases (CRD), Pune. Based on our long term experience, we also report some contemporary issues of concern.

Background

Stanford HAQ (S-HAQ) and several versions are used worldwide to measure physical function. Based on traditions and life style, a maiden Indian version (CRD Pune) was developed and used extensively (1996-2011). We report clinimetric properties and long term use.

Methods

The Indian version was finalized in a step wise consensus building process between doctors, community and patients. It remained similar to S-HAQ in basic structure (categories) and score/disability index. Current data was selected from controlled drug trials in active RA, referral community patients (clinic and camps) and WHO ILAR COPCORD (community oriented program for control of rheumatic diseases) Bhigwan. Standard statistics were used; significant p
Results

Test-retest and correlation statistics confirmed face and content (Cronbach’s index >0.8) and construct validity and reliability at several time points. There was fair to good (0.2-0.6) correlation between Indian HAQ and pain visual analog scale, joint counts for pain/tenderness and swelling, sedimentation rate and radiological score (joint damage). The efficacy variables explained up to 70% variation in HAQ (dependent) regression models. The Indian HAQ scored significantly higher than the S-HAQ but the difference was not clinically relevant. The Indian HAQ was sensitive to change (effect size 0.7) over 24 week treatment with hydroxychloroquin. Generic use in COPCORD survey showed moderately severe HAQ disability in all patient groups including ‘ill-defined aches’ and soft tissue rheumatism. HAQ improved patient satisfaction.

Conclusion

The Indian HAQ (CRD Pune) was a valid and useful patient outcome measure and improved compliance (long term follow up).
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